Provider Demographics
NPI:1699391300
Name:JC MOBILE PHLEBOTOMY SERVICES, LLC
Entity Type:Organization
Organization Name:JC MOBILE PHLEBOTOMY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACE
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PHLEBOTOMY
Authorized Official - Phone:386-872-2581
Mailing Address - Street 1:PO BOX 290474
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-0474
Mailing Address - Country:US
Mailing Address - Phone:386-872-2581
Mailing Address - Fax:386-961-4401
Practice Address - Street 1:6047 BURGUNDY TER
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-6785
Practice Address - Country:US
Practice Address - Phone:386-872-2581
Practice Address - Fax:386-961-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty